For many people, the first unwanted signs of aging are on the neck and jowl region.

There are some non-surgical options for these areas, such as Thermage. Thermage is probably the best non-surgical alternative, in my opinion, and the longest lasting. Its effects, however, are different than surgery’s more dramatic changes. Surgery is like having your dress or pants taken in a bit on the sides - skin is actually removed, and the muscles underneath are tightened. With Thermage, the skin or fabric itself is “re-sized,” sort of like putting that dress in the dryer or steaming it to re-size it; the skin or fabric actually tightens. After this office procedure you look totally normal. Many people can really benefit from both Thermage and from surgery.

The thread lift was another type of mini-surgical option that was very popular last year. I never performed this procedure but was intrigued by the concept. The thread devices have now been recalled after problems developed.

Still, facelift surgery remains the gold standard of facial rejuvenation. Its effects are proven, dramatic and long lasting. But surgery is surgery and has the attendant risks – risks of surgery, scars, recovery time, expense, pain. Sometimes, though, without surgery, your problems just will not get any better. It’s that “getting older” thing. People always ask, when should I consider surgery? My answer is, when it starts to bother you. When you become self conscious about looking down or hate seeing pictures or videos of yourself, it’s time to come in to at least talk about it. And I will tell you if I think you are silly.

There are so many variations on facelift techniques: the quicklift, the lifestyle lift, mini-lifts, neck lifts, each promising safer surgery, with faster recovery and fewer complications than the next. But realistically, none can be done over the lunch break and have you back at work by three. However, there have been some new and exciting, innovations. I believe very reliable results with relatively few complications can be achieved with some of these techniques.

First, then, the mini-lift, lifestyle lift, quick lift and MACS–lift (minimal access cranial suspension) are all variations on a theme. Basically the surgical approach is in front of the ear, with very little dissection done behind the ear. The incision zig-zags in front of the hairline at the temples, and then down, sort of inside the ear, and then sweeps to the bottom of your ear. This can result in significant improvement for the cheeks and jowls, and does help the neck some. But you are really relying on an upward pull, to help lift the neck (or area under the chin) rather than dealing with any muscle laxity there directly. Usually some liposuction is added under the chin, to try to alleviate any hanging tissue. The major advantage of this technique is that it can typically be done under local anesthesia, so the costs of the hospital are avoided. There is not too much discomfort, and if no fat transfers are included, downtime is minimal – usually a week to ten days. I see a lot of patients now who would rather have less surgery, more often, and this suits their time constraints nicely. It is a little tuck-up, but can really DO something. I have been having a lot of fun with these little lifts lately. You will see results! AND if you need the big lift later, no problem. Another lift can easily be done at a later date, when you really get saggy.

Second, and if you have a lot of skin under the chin, then a neck lift is really for you. Do an honest assessment under your chin, and if more than an inch of skin is hanging down, it’s a neck lift for you! A lot of this is related to genetics and how you are genetically programmed to age. (It’s your mother’s fault!) A necklift is usually combined with a facelift, but basically it adds surgery for the bottom of your face, and under the chin, along with the two sides of your face. In other words, this more extensive surgery involves the two cheeks, the chin, and the area behind your ears. This really addresses those loose muscles, the platysma muscles, that are like two three inch wide ribbons that hang from the sides of your mouth and cheek, and drape down onto your chest. As we age, those two ribbons of platysma muscle lose their tightness – and start to hang. You can usually see the edges hang down below the chin, like a double swag. Tightening these muscles, and sometimes even sectioning a strip, to make them support your chin like a hammock, is probably the best way to really give a sharp angle to the neck. It is, without a doubt, a very long lasting correction, and I know you will enjoy the results for years! But it does require more downtime, more expense, and a bit more recovery.

All of these procedures can be combined safely with a other procedures – fat transfers, eyelid lifts, chemical peels, etc.

I hope this helps take some of the mystery out of facial rejuvenation surgery. Here are some examples of what surgery did for a few individuals. I have many more pictures at my office.

View our Faces Before and After Photos.